The impact of referral workload on cardiology registrars in a high-volume district general hospital: implications for workforce well-being and service efficiency
Introduction: Cardiology specialty registrars (SpRs) in district general hospitals (DGHs) have a crucial role managing complex inpatient referrals and clinical decision-making. However, rising admissions and referral volumes have escalated their workload, potentially compromising training quality an...
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| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-06-01
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| Series: | Future Healthcare Journal |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2514664525002152 |
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| Summary: | Introduction: Cardiology specialty registrars (SpRs) in district general hospitals (DGHs) have a crucial role managing complex inpatient referrals and clinical decision-making. However, rising admissions and referral volumes have escalated their workload, potentially compromising training quality and patient safety.1 High workloads, frequent interruptions and multitasking are associated with cognitive overload, decision-making fatigue and increased risk of medical errors.2,3 Additionally, heavy workloads and associated stress have been linked to substantial burnout rates (76%) among UK cardiology trainees.4 This growing issue raises concerns about registrar well-being, workforce sustainability and care quality, prompting calls from professional bodies for urgent intervention.5 This study aimed to quantify referral workload, examine its impact on registrar well-being and identify specific challenges affecting service efficiency. Materials and methods: This mixed-methods study was conducted over 2 weeks in October 2024 at Northwick Park Hospital. All inpatient cardiology referrals were audited for total referral volume, weekday versus weekend patterns and referral method (electronic vs bleep-based). Detailed data on referral source and consultation mode (face-to-face or remote) were collected from 120 consecutive referrals during the initial 5 days. A structured survey was distributed to 12 cardiology registrars, achieving a 92% response rate, assessing workload perception, stress, exhaustion, bleep volume impact, consultant support and training limitations. Descriptive statistics were employed to summarise findings. Chi-square tests and non-parametric correlation analyses evaluated relationships among workload perception, stress and exhaustion. Results and discussion: During the 2-week audit, cardiology SpRs managed an average of 60 inpatient referrals per weekday, decreasing notably to 24 on weekends. Detailed analysis of 120 referrals showed 59% originated from acute medical wards. Despite an established electronic referral system, SpRs experienced high volumes of bleep-based interruptions (average 29 per shift, increasing to 34.5 on weekdays), disrupting workflow and increasing cognitive load.A survey among SpRs highlighted persistent workload challenges: 42% described their workload as unmanageable, 33% were neutral and only 25% found it manageable. This burden significantly affected well-being, with 91% reporting frequent stress and 25% consistently feeling overwhelmed. Correlation analysis indicated a possible association between higher workload and increased stress (ρ = 0.55, p = 0.077).Additionally, 91% experienced moderate-to-severe physical exhaustion by shift end, with 33% rating fatigue as severe. Furthermore, 82% reported insufficient time for breaks, limiting rest and recovery during demanding shifts. Despite these challenges, 91% acknowledged the educational value of managing acute referrals.Consultant support was generally positive, with 81.8% rating it adequate. While no significant association was found with workload perception (χ² p = 0.569), a non-significant trend (ρ = –0.55, p = 0.082) suggested that greater support may enhance workload manageability. Conclusion: This study highlights significant workload pressures faced by cardiology registrars managing inpatient referrals in a high-volume DGH setting, negatively affecting their well-being and increasing risks of stress and exhaustion. Despite generally positive consultant support, findings underline the need for targeted improvements in referral processes, workload management and registrar support systems. Addressing these issues is essential to safeguard training quality, ensure patient safety and promote long-term workforce sustainability. |
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| ISSN: | 2514-6645 |